Patient experience with discharge instructions in postdischarge recovery: a qualitative study
Patient experience with discharge instructions in postdischarge recovery: a qualitative study
复制标题
DOI：
10.1136/bmjopen-2016-014842
复制
发表时间：
2017-02-01
期刊：
影响因子：
2.9
通讯作者：
Naik, Aanand D.
中科院分区：
文献类型：
--
作者：
Horstman, Molly J.;Mills, Whitney L.;Naik, Aanand D.
目的：我们研究了出院指示的作用，在术后恢复的患者接受结直肠手术和报告主题相关的病人的看法出院指示和postdischarge experience.Design：半结构化的访谈进行了一个项目再造出院干预适应手术patients.Setting形成性评价的一部分。DeBakey VA医疗中心，德克萨斯州休斯顿的一个三级转诊中心。参与者：12名接受择期结直肠手术的患者。在术后两周的预约中进行访谈。结果：参与者表现出对出院指示内容的理解。在访谈中，参与者报告了几个积极的作用，出院后的护理出院指示：安全感，提醒住院教育，一个活的文件和授权的来源。尽管有这些积极的联系，但参与者报告说，指示提供的信息不足以促进获得有效解决出院后严重问题的护理。与会者指出，难以达到供应商出院后，这导致通过变通办法，以克服系统barriers.Conclusions：尽管齐心协力，提供以病人为中心的指示，出院指示没有提供足够的背景下，有效地指导出院后的互动与医疗保健系统。关于如何与医疗保健系统中最合适的人员接触和沟通的信息不足是患者接受高质量出院后护理的重要障碍。团队培训计划中的工具和策略，如提高绩效和患者安全的团队策略和工具，可以进行调整，以纳入患者，并为他们提供出院后与医疗保健提供者沟通的结构化方法。
Objectives: We examined the role of discharge instructions in postoperative recovery for patients undergoing colorectal surgery and report themes related to patient perceptions of discharge instructions and postdischarge experience.Design: Semistructured interviews were conducted as part of a formative evaluation of a Project ReEngineered Discharge intervention adapted for surgical patients.Setting: Michael E. DeBakey VA Medical Center, a tertiary referral centre in Houston, Texas.Participants: Twelve patients undergoing elective colorectal surgery. Interviews were conducted at the two-week postoperative appointment.Results: Participants demonstrated understanding of the content in the discharge instructions. During the interviews, participants reported several positive roles for discharge instructions in their postdischarge care: a sense of security, a reminder of inhospital education, a living document and a source of empowerment. Despite these positive associations, participants reported that the instructions provided insufficient information to promote access to care that effectively addressed acute issues following discharge. Participants noted difficulty reaching providers after discharge, which resulted in the adoption of workarounds to overcome system barriers.Conclusions: Despite concerted efforts to provide patient-centred instructions, the discharge instructions did not provide enough context to effectively guide postdischarge interactions with the healthcare system. Insufficient information on how to access and communicate with the most appropriate personnel in the healthcare system is an important barrier to patients receiving high-quality postdischarge care. Tools and strategies from team training programmes, such as team strategies and tools to enhance performance and patient safety, could be adapted to include patients and provide them with structured methods for communicating with healthcare providers post discharge.